Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report
Makoto Saito1, Masanobu Morioka2, Koh Izumiyama2
1Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan. ikyoku@aiiku-hp.or.jp.
Background:
Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG.
Case Summary:
The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics.
Conclusion:
The histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".
Insights
Phlegmonous gastritis (PG) is a rare bacterial infection. This case highlights neutropenic necrotizing gastritis caused by Bacillus cereus, complicated by hepatic portal venous gas (HPVG) in an immunocompromised patient.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Hematology
Background:
- Phlegmonous gastritis (PG) is a rare bacterial infection of the gastric wall, typically caused by Streptococcus pyogenes.
- Hepatic portal venous gas (HPVG) is a serious condition rarely associated with PG.
Observation:
- A 70-year-old woman with acute lymphocytic leukemia developed septic shock with severe neutropenia (100/μL WBC).
- Imaging revealed gastric wall thickening and HPVG. Endoscopy showed pseudomembranous lesions.
- Gastric biopsies showed necrosis and lymphocytes, not neutrophils, with Bacillus cereus identified on culture.
Findings:
- The patient was diagnosed with PG induced by Bacillus cereus sepsis, complicated by HPVG.
- Histopathology was characterized as "neutropenic necrotizing gastritis" due to the absence of neutrophils.
Implications:
- This case expands the understanding of PG etiologies and presentations, particularly in neutropenic patients.
- Successful conservative management with carbapenem antibiotics highlights treatment options for this rare condition.
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